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Plaikner M, Lanser L, Kremser C, Weiss G, Henninger B. 1.5-T MR relaxometry in quantifying splenic and pancreatic iron: retrospective comparison of a commercial 3D-Dixon sequence and an established 2D multi-gradient echo sequence. Eur Radiol 2023; 33:4973-4980. [PMID: 36800012 PMCID: PMC10289981 DOI: 10.1007/s00330-023-09451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To compare the quantitative measurement of splenic and pancreatic iron content using a commercial 3D-Dixon sequence (qDixon) versus an established fat-saturated R2* relaxometry method (ME-GRE). METHODS We analyzed splenic and pancreatic iron levels in 143 MR examinations (1.5 T) using the qDixon and a ME-GRE sequence (108 patients: 65 males, 43 females, mean age 61.31 years). Splenic and pancreatic R2* values were compared between both methods using Bland-Altman plots, concordance correlation coefficients (CCC), and linear regression analyses. Iron overload (R2* > 50 1/s) was defined for both organs and compared using contingency tables, overall agreement, and Gwet's AC1 coefficient. RESULTS Of all analyzable examinations, the median splenic R2* using the qDixon sequence was 25.75 1/s (range: 5.6-433) and for the ME-GRE sequence 35.35 1/s (range: 10.9-400.8) respectively. Concerning the pancreas, a median R2* of 29.93 1/s (range: 14-111.45) for the qDixon and 31.25 1/s (range: 14-97) for the ME-GRE sequence was found. Bland-Altman analysis showed a mean R2* difference of 2.12 1/s with a CCC of 0.934 for the spleen and of 0.29 1/s with a CCC of 0.714 for the pancreas. Linear regression for the spleen/pancreas resulted in a correlation coefficient of 0.94 (p < 0.001)/0.725 (p < 0.001). Concerning iron overload, the proportion of overall agreement between the two methods was 91.43% for the spleen and 93.18% for the pancreas. CONCLUSIONS Our data show good concordance between R2* values obtained with a commercial qDixon sequence and a validated ME-GRE relaxometry method. The 3D-qDixon sequence, originally intended for liver assessment, seems to be a reliable tool for non-invasive evaluation of iron content also in the spleen and the pancreas. KEY POINTS • A 3D chemical shift imaging sequence and 2D multi-gradient echo sequence show good conformity quantifying splenic and pancreatic R2* values. • The 3D chemical shift imaging sequence allows a reliable analysis also of splenic and pancreatic iron status. • In addition to the liver, the analysis of the spleen and pancreas is often helpful for further differential diagnostic clarification and patient guidance regarding the iron status.
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Affiliation(s)
- Michaela Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lukas Lanser
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Günter Weiss
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Measurement of spleen fat on MRI-proton density fat fraction arises from reconstruction of noise. Abdom Radiol (NY) 2019; 44:3295-3303. [PMID: 31172210 DOI: 10.1007/s00261-019-02079-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE This study compares splenic proton density fat fraction (PDFF) measured using confounder-corrected chemical shift-encoded (CSE)-MRI to magnetic resonance spectroscopy (MRS) in human patients at 3T. METHODS This was a prospectively designed ancillary study to various previously described single-center studies performed in adults and children with known or suspected nonalcoholic fatty liver disease. Patients underwent magnitude-based MRI (MRI-M), complex-based MRI (MRI-C), high signal-to-noise variants (Hi-SNR MRI-M and Hi-SNR MRI-C), and MRS at 3T for spleen PDFF estimation. PDFF from CSE-MRI methods were compared to MRS-PDFF using Wilcoxon signed-rank tests. Demographics were summarized descriptively. Spearman's rank correlations were computed pairwise between CSE-MRI methods. Individual patient measurements were plotted for qualitative assessment. A significance level of 0.05 was used. RESULTS Forty-seven patients (20 female, 27 male) including 12 adults (median 55 years old) and 35 children (median 12 years old). Median PDFF estimated by MRS, MRI-M, Hi-SNR MRI-M, MRI-C, and Hi-SNR MRI-C was 1.0, 2.3, 1.9, 2.2, and 2.0%. The four CSE-MRI methods estimated statistically significant higher spleen PDFF values compared to MRS (p < 0.0001 for all). Pairwise associations in spleen PDFF values measured by different CSE-MRI methods were weak, with the highest Spearman's rank correlations being 0.295 between MRI-M and Hi-SNR MRI-M; none were significant after correction for multiple comparisons. No qualitative relationship was observed between PDFF measurements among the various methods. CONCLUSION Overestimation of PDFF by CSE-MRI compared to MRS and poor agreement between related CSE-MRI methods suggest that non-zero PDFF values in human spleen are artifactual.
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Ivancev K, Lunderquist A, McCuskey R, McCuskey P, Wretlind A. Experimental Investigation of a New Iodinated Lipid Emulsion for Computed Tomography of the Liver. Acta Radiol 2016. [DOI: 10.1177/028418518903000416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Iodinated lipid emulsions are highly efficient macrophage imaging agents. Nevertheless, none of them has been accepted for clinical use because of adverse reactions. We have tested a new iodinated lipid emulsion, Intraiodol. The size and surface properties of the particles of this emulsion are similar to those of Intralipid which in turn closely resemble the naturally occurring chylomicrons. Using computed tomography (CT) of the rabbit liver as well as vital microscopy and electron microscopy of the rat liver we found that Intraiodol has low efficiency as a liver-specific contrast medium because its particles are predominantly taken up by the hepatocytes and to a less extent by the Kupffer cells, as is Intralipid. The low efficiency of Intraiodol could be fully compensated by an increase in dosage without any significant effect on sinusoidal blood flow. This in turn suggests that the likelihood of release of toxic mediators (and thereby related adverse reactions from activated macrophages) is reduced. We believe that this new way of delivering iodinated lipid particles to the liver represents an important advance in the search for a non-toxic lipid emulsion for CT of the liver.
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Stejskal V, Kouřil J, Policar T, Svobodová Z. Splenic lipidosis in intensively cultured perch, Perca fluviatilis L. JOURNAL OF FISH DISEASES 2016; 39:87-93. [PMID: 25589287 DOI: 10.1111/jfd.12327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/29/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
Macroscopically visible lipid deposition varying in size from pinpoint to 8-mm diameter was found in spleens of a population of intensively farmed perch, Perca fluviatilis L. over a 24-month rearing period. Large agglomerates of adipocytes distinguishable from surrounding normal tissue occurred in all individuals with spleen lipidosis. Several affected fish presented total dystrophy of large clusters of hepatocytes. Prevalence of lipidosis was 5.0% at 12 months and 16.6% at 24 months. There was no significant difference between fatty acid profiles of liver or perivisceral fat of perch with and without lipidosis except for linoleic, myristic, γ-linoleic, cis-eicosatrienic, palmitooleic acid. Body weight and hepatosomatic, perivisceral fat and splenosomatic indices were not associated with lipidosis. There was no significant effect of lipidosis on mortality or growth.
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Affiliation(s)
- V Stejskal
- South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Institute of Aquaculture, Faculty of Fisheries and Protection of Waters, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - J Kouřil
- South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Institute of Aquaculture, Faculty of Fisheries and Protection of Waters, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - T Policar
- South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Institute of Aquaculture, Faculty of Fisheries and Protection of Waters, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Z Svobodová
- South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Institute of Aquaculture, Faculty of Fisheries and Protection of Waters, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
- Faculty of Veterinary Hygiene and Ecology, Veterinary Public Health and Animal Welfare, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
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Incidental adrenal lesions detected on enhanced abdominal dual-energy CT: can the diagnostic workup be shortened by the implementation of virtual unenhanced images? Eur J Radiol 2014; 83:1746-51. [PMID: 25064663 DOI: 10.1016/j.ejrad.2014.06.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/11/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine whether post-processing of the data from portal-phase enhanced dual-energy CT (DECT), with or without the addition of a late enhanced phase acquisition, may enable characterization of adrenal lesions without the need for acquisition of pre-contrast images. MATERIALS AND METHODS Twenty-two patients with 24 adrenal lesions underwent unenhanced, venous and delayed phase DECT. Of these lesions, 20 were found to be adrenal adenomas, on the basis of histopathology, unenhanced attenuation values between 0 and -10 HU, or stability over at least 6 months. For all 24 lesions, true and virtual unenhanced attenuation values were measured based on the data of the portal (VNCp) and the delayed (VNCd) DECT acquisition. The absolute washout values based on the true non-contrast (TNC) and the VNCp and VNCd image series were also measured. The washout was also calculated based on the iodine concentration measured from both contrast-enhanced acquisitions. RESULTS Mean virtual unenhanced attenuation values of all lesions calculated from the portal phase images was 12.6 HU, and was 4.02 HU higher than the values based on true unenhanced images (p=0.020). Washout values calculated from virtual unenhanced attenuation based on the VNCp were also significantly different (p=0.0304) while those calculated from VNCd and from iodine concentration correlated with the corresponding values based on the true unenhanced values (p>0.999). CONCLUSIONS Our data indicate that attenuation values of adrenal adenomas based on virtual unenhanced images are significantly higher than those obtained with true unenhanced images. An incidental adrenal lesion with a virtual unenhanced attenuation lower than 10 HU can thus be safely characterized as an adenoma.
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Leitão HS, Paulino C, Rodrigues D, Gonçalves SI, Marques C, Carvalheiro M, Geraldes CF, Caseiro-Alves F. MR fat fraction mapping: a simple biomarker for liver steatosis quantification in nonalcoholic fatty liver disease patients. Acad Radiol 2013; 20:957-61. [PMID: 23830602 DOI: 10.1016/j.acra.2013.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/27/2013] [Accepted: 05/07/2013] [Indexed: 01/06/2023]
Abstract
RATIONALE AND OBJECTIVES To assess the performance, postprocessing time, and intra- and interobserver agreement of a simple magnetic resonance-based mapping technique to quantify liver fat. MATERIALS AND METHODS This prospective, single-center study included 26 patients who were overweight with type 2 diabetes and at risk for nonalcoholic fatty liver disease. Mapping of the liver was based on a triple echo gradient-echo sequence, and (1)H magnetic resonance spectroscopy was used as the reference standard. The nonparametric Spearman correlation coefficient and the Wilcoxon test were used for comparisons between mapping and spectroscopy. The mapping was assessed for its predictive performance using the area under the curve of a receiver operating characteristic curve. Intraclass correlation coefficients were used to calculate intra- and interobserver's agreement for mapping measurements. RESULTS Patients had a mean fat percentage of 11.7% (range, 2-35.4%). A strong correlation was seen between mapping and spectroscopy (r = 0.89, P < .0001). A cutoff of 6.9% for fat fraction mapping was found to diagnose steatosis with 93% sensitivity and 100% specificity with an area under the curve of 0.99. Mapping of the liver had shorter acquisition and post-processing times than spectroscopy (5 min vs. 38 min; P < .0001). Mapping measurements had an intra- and interobserver agreement of 0.98 and 0.99, respectively. CONCLUSIONS The magnetic resonance-based liver mapping can accurately quantify liver fat with a cutoff value of 6.9% and excellent intra- and interobserver agreement. This mapping technique, with its simple methodology and short postprocessing time, has the potential to be included in routine abdominal protocols.
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el-Ebiary M, Torres A, Ramirez J, Xaubet A, Rodriguez-Roisin R. Lipid deposition during the long-term infusion of propofol. Crit Care Med 1995; 23:1928-30. [PMID: 7587272 DOI: 10.1097/00003246-199511000-00022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M el-Ebiary
- Servei de Pneumologia i Allèrgia Respiratòria, Universitat de Barcelona, Spain
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Hinton PS, Peterson CA, Lo HC, Yang H, McCarthy D, Ney DM. Insulin-like growth factor-I enhances immune response in dexamethasone-treated or surgically stressed rats maintained with total parenteral nutrition. JPEN J Parenter Enteral Nutr 1995; 19:444-52. [PMID: 8748358 DOI: 10.1177/0148607195019006444] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND New evidence suggests that insulin-like growth factor-I (IGF-I) is an important regulator of immune response. Our objective was to determine the effects of IGF-I on immune response during total parenteral nutrition (TPN) using two stress models. METHODS Male, Sprague-Dawley rats (230 to 250 g) were given TPN with or without coinfusion of recombinant human IGF-I (800 micrograms/d for 6 days) and subjected to either dexamethasone, a synthetic glucocorticoid, or surgical stress, in the form of a midline abdominal incision. In the dexamethasone model, immune response was assessed by total cellularity of the thymus and spleen, in vitro assays of lymphocyte proliferation, and interleukin 6 (IL-6) production, and concentrations of IL-6 and tumor necrosis factor alpha (TNF-alpha) in serum. In the surgical model, flow cytometry was used to identify and quantify splenic populations of T and B lymphocytes and macrophages. RESULTS In rats immunosuppressed by dexamethasone, IGF-I infusion increased mitogen-induced proliferation of thymocytes, but did not alter cellularity in the thymus; enhanced proliferation and IL-6 production in peripheral blood mononuclear cells following treatment with concanavalin A or lipopolysaccharide; and reduced the serum concentration of IL-6, but not TNF-alpha. In surgically stressed rats, IGF-I infusion restored the splenic populations of immature and mature B lymphocytes, which were decreased by TPN. CONCLUSIONS our data demonstrate that IGF-1 enhances immune response during TPN in rats.
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Affiliation(s)
- P S Hinton
- Department of Nutritional Sciences, University of Wisconsin-Madison 53706, USA
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Gempeler F, Elston AC, Thompson SP, Park GR. Propofol and intralipid cause creaming of serum from critically ill patients. Anaesthesia 1994; 49:17-20. [PMID: 7508691 DOI: 10.1111/j.1365-2044.1994.tb03305.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of this in-vitro study was to investigate the incidence of propofol agglutination with serum from critically ill patients. Serum (400 microliters) from 58 critically ill patients and 30 healthy volunteers was incubated with 10 microliters of either propofol, Intralipid 10% or Intralipid 20%. Control incubations contained serum only. At 24 h, the serum was examined macroscopically and microscopically for agglutination. Agglutination was seen with Intralipid 20% in serum from all critically ill patients and 13.3% of volunteers. Serum from 91.4% of critically ill patients was agglutinated with Intralipid 10% and only 3.3% of the healthy volunteers. In comparison, propofol produced agglutination in 74.1% of critically ill patients and in none of the serum from healthy volunteers (p < 0.05 propofol versus Intralipid 10%, p < 0.0001 propofol versus Intralipid 20%). No correlation was seen between agglutination and age, sex, APACHE II score or plasma concentration of acute phase proteins. However, agglutination of propofol and Intralipid 10% was more frequent (p < 0.001) in serum from patients with pulmonary disease, than in patients with normal lungs. The clinical implications of these in-vitro findings are unclear and need further investigation.
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Affiliation(s)
- F Gempeler
- John Farman Intensive Care Unit, Addenbrook's Hospital, Cambridge
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10
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Abstract
1. Until recently, when drugs were used in critically ill patients they were expected to behave in the same way as in less seriously ill patients. Now the unpredictability of even the most reliable drugs has been recognized. With this there is an awareness of the adverse effects drugs may have on organs other than the ones the drug was intended to act on. In patients with multiorgan dysfunction, poly-pharmacy is usually needed. The drugs may not only interfere with the action of each other at the receptor and enzyme level, but may also change protein binding and elimination. All these effects may be unimportant in less seriously ill patients, but may affect outcome in the critically ill. A high degree of awareness and suspicion of unknown drug-induced adverse reaction is needed by clinicians and pharmacologists alike.
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Affiliation(s)
- G R Park
- John Farman Intensive Care Unit, Addenbrooke's NHS Trust, Cambridge, UK
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Gollaher CJ, Fechner K, Karlstad M, Babayan VK, Bistrian BR. The effect of increasing levels of fish oil-containing structured triglycerides on protein metabolism in parenterally fed rats stressed by burn plus endotoxin. JPEN J Parenter Enteral Nutr 1993; 17:247-53. [PMID: 8505830 DOI: 10.1177/0148607193017003247] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This report investigates the effect of various levels of medium-chain/fish oil structured triglycerides on protein and energy metabolism in hypermetabolic rats. Male Sprague-Dawley rats (192 to 226 g) were continuously infused with isovolemic diets that provided 200 kcal/kg per day and 2 g of amino acid nitrogen per kilogram per day. The percentage of nonnitrogen calories as structured triglyceride was varied: no fat, 5%, 15%, or 30%. A 30% long-chain triglyceride diet was also provided as a control to compare the protein-sparing abilities of these two types of fat. Nitrogen excretion, plasma albumin, plasma triglycerides, and whole-body and liver and muscle protein kinetics were determined after 3 days of feeding. Whole-body protein breakdown, flux, and oxidation were similar in all groups. The 15% structured triglyceride diet maximized whole-body protein synthesis (p < .05). Liver fractional synthetic rate was significantly greater in animals receiving 5% of nonprotein calories as structured triglyceride (p < .05). Muscle fractional synthetic rate was unchanged. Plasma triglycerides were markedly elevated in the 30% structured triglyceride-fed rats. The 30% structured triglyceride diet maintained plasma albumin levels better than those diets containing no fat, 5% medium-chain triglyceride/fish oil structured triglyceride, or 30% long-chain triglycerides. Nitrogen excretion was lower in animals receiving 30% of nonnitrogen calories as a structured triglyceride than in those receiving 30% as long-chain triglycerides, but this difference did not reach statistical significance (p = .1). These data suggest that protein metabolism is optimized when structured triglyceride is provided at relatively low dietary fat intakes.
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Affiliation(s)
- C J Gollaher
- Laboratory of Nutrition/Infection, New England Deaconess Hospital, Harvard Medical School, Boston, MA 02215
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12
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The influence of intermittent infusion, age and strain on organ changes after complete parenteral nutrition in rat. Clin Nutr 1988. [DOI: 10.1016/0261-5614(88)90015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Degott C, Messing B, Moreau D, Chazouillères O, Paris R, Colombel JF, Lebrec D, Potet F, Feldmann G, Benhamou JP. Liver phospholipidosis induced by parenteral nutrition: histologic, histochemical, and ultrastructural investigations. Gastroenterology 1988; 95:183-91. [PMID: 3131177 DOI: 10.1016/0016-5085(88)90309-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Histochemical and electron microscopic examinations of the liver were performed in 5 adults receiving parenteral nutrition for greater than 18 mo and in 4 adults receiving parenteral nutrition for less than 5 mo. Phospholipidosis, reflected by the presence of cytoplasmic phospholipid deposits at histochemical examination and the presence of multilamellar lysosomes at electron microscopy, was marked and present in hepatocytes, Kupffer cells, and portal macrophages in all 5 patients receiving parenteral nutrition for greater than 18 mo. Mild phospholipidosis, affecting only hepatocytes, was demonstrated in 3 of the 4 patients receiving parenteral nutrition for less than 5 mo. These findings indicate that liver phospholipidosis is relatively common in patients receiving parenteral nutrition and that the degree of liver phospholipidosis depends on the duration of parenteral nutrition. Liver phospholipidosis might be due to intrahepatic accumulation of intravenous phospholipids provided by fat-emulsion sources.
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Affiliation(s)
- C Degott
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Beaujon, Clichy, France
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14
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Grimble G, Silk D. Reply to Letter by J. Main Et Al. JPEN J Parenter Enteral Nutr 1986. [DOI: 10.1177/014860718601000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hamawy KJ, Moldawer LL, Georgieff M, Valicenti AJ, Babayan VK, Bistrian BR, Blackburn GL. The Henry M. Vars Award. The effect of lipid emulsions on reticuloendothelial system function in the injured animal. JPEN J Parenter Enteral Nutr 1985; 9:559-65. [PMID: 3930762 DOI: 10.1177/0148607185009005559] [Citation(s) in RCA: 133] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Use of intravenous lipid emulsions in trauma and sepsis still remains controversial. In order to examine the impact lipid emulsions have on host defense against bacterial infection during total parenteral nutrition (TPN), 56 male Sprague-Dawley rats underwent jugular cannulation and were randomly divided into three groups, each receiving one of three TPN regimens. All regimens delivered approximately 250 kcal/kg X body weight/day, of which 12.5 g were as amino acids. Group 1 received 100% of the nonprotein calories as glucose (AA + G). Group 2 was given 50% of the nonprotein calories as a longchain triglyceride emulsion (100% LCT). Group 3 received 50% of nonprotein calories as a mixed lipid system, composed of medium- and long-chain triglycerides (75% MCT/25% LCT). After 24 hr on intravenous nutrition, all animals received bilateral septic femur fractures and were continued on TPN for 3 days. On the last day, the level of bacteremia and the in vivo response to an intravenous challenge of 59Fe-labeled Escherichia coli were examined. Three days following the septic injury, animals given MCT as part of their lipid calories were not bacteremic, whereas the other groups had greater than 10(2) cfu/ml of blood. Animals receiving TPN with MCT sequestered a greater percentage of exogenously administered bacteria in the liver and sequestered less in the lung compared to animals given 100% LCT (p less than 0.05). From these data, we conclude that parenteral nutrition formulas where LCT has been partially replaced with MCT may better support host bactericidal capacity than similar regimens comprised of LCT as the sole lipid source.
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Horowitz GD, Groeger JS, Legaspi A, Lowry SF. The response of fibronectin to differing parenteral caloric sources in normal man. JPEN J Parenter Enteral Nutr 1985; 9:435-8. [PMID: 3928916 DOI: 10.1177/0148607185009004435] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between circulating fibronectin concentration and nutritional status was examined in eight healthy male (31 +/- 1 yr old) volunteers in three nutritional states: the postabsorptive state, after 10 days of protein-caloric starvation, and during the 10th day of refeeding by total parenteral nutrition. Plasma fibronectin was significantly decreased from 330 +/- 22 to 154 +/- 11 micrograms/ml (p less than 0.001) from the postabsorptive to starved state which was accompanied by appropriate changes in body weight, anthropometric measurements, and nitrogen balance. Plasma fibronectin levels were restored to 402 +/- 39 micrograms/ml following 10 days of total parenteral nutrition. The plasma fibronectin response was greater (p less than 0.05) during total parenteral nutrition with dextrose as the nonprotein calorie source as compared to a 50% dextrose/50% lipid regimen. These results suggest that the calorie source must be considered during interpretation of plasma fibronectin levels in patients undergoing parenteral nutrition.
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Klein EA, Montague DK, Steiger E. Priapism associated with the use of intravenous fat emulsion: case reports and postulated pathogenesis. J Urol 1985; 133:857-9. [PMID: 3921725 DOI: 10.1016/s0022-5347(17)49257-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
During the 8 years since inception of a home total parenteral nutrition program in 35 male patients 2 suffered priapism related temporally to the weekly intravenous infusion of 20 per cent fat emulsion. Fat emulsions have been shown to cause hypercoagulability, capillary thrombosis and fat embolus in in vivo and in vitro experiments. Autopsies of patients treated with intravenous fat emulsion have revealed capillary engorgement and fat embolus with associated organ infarction. We postulate that fat emulsions may cause priapism in these patients. Because of the more frequent occurrence of priapism in this small subset of patients we now recommend that 1) patients be informed of this potential complication before hyperalimentation is begun, 2) the less concentrated 10 per cent emulsion should be used twice weekly, rather than the 20 per cent emulsion weekly, and should be infused during at least 4 hours, and 3) the fat emulsion should be added to other components of the intravenous regimen, when possible, to dilute the fat and prolong its administration time.
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Mayfield C, Nordenström J. Creaming and plasma clearance rate of intravenous fat emulsion in critically ill patients. Clin Nutr 1984; 3:93-7. [PMID: 16829441 DOI: 10.1016/s0261-5614(84)80006-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Intravenous fat emulsion incubated with serum or plasma in vitro may result in the aggregation of fat (creaming). Twenty critically ill patients were tested for in vitro creaming of the fat emulsion Intralipid. An intravenous fat tolerance test was used to determine the plasma clearance rate of Intralipid in each patient. Eleven patients (55%) were found to be creamers. These patients had a higher mean plasma clearance rate of Intralipid than non-creamers (5.73 +/- 0.56 vs. 2.77 +/- 0.37% per min; p < 0.001); however, the rates of both groups were within the range reported in normal healthy subjects. Mean C-reactive protein concentration was significantly higher (p < 0.01), and albumin levels were lower (p < 0.01) in creamers compared to non-creamers. Ionized calcium levels did not differ between the two groups. The results of this study indicate that in vitro creaming is common in acutely ill patients. The clinical significance of creaming is probably minimal since creamers tolerated 50 to 100 g/day of intravenous fat emulsion while receiving total parenteral nutrition. Creaming was uncommon when the fat was mixed with blood in vitro.
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Affiliation(s)
- C Mayfield
- Department of Surgery, Huddinge University Hospital, S-141 86 Huddinge, Sweden
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Fraser I, Neoptolemos J, Darby H, Bell PR. The effects of intralipid and heparin on human monocyte and lymphocyte function. JPEN J Parenter Enteral Nutr 1984; 8:381-4. [PMID: 6431127 DOI: 10.1177/0148607184008004381] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A group of patients were studied during the infusion of Intralipid as part of a parenteral nutrition regimen. Peripheral blood lymphocyte function was unaffected, but monocyte function (chemotaxis) was significantly depressed. A group of healthy volunteers received an intravenous bolus of 20% Intralipid. Blood was taken before and 15 min afterward for immunological studies, and the same changes were seen following Intralipid. Prior subcutaneous injection of 5000 U of heparin did not affect either immunological parameter, but completely prevented the changes in monocyte function caused by Intralipid. Electronmicrographs of monocytes from volunteers after injection of Intralipid, and autoradiographs of cells incubated with 14C-Intralipid in vitro, showed phagocytosis of fat particles by monocytes. These data suggest that Intralipid can have potentially serious side effects on the immune system, and that they may be alleviated by the use of subcutaneous heparin.
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20
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Fraser I, Neoptolemos J, Woods P, Bowry V, Bell PR. The effect of intralipid on human lymphocyte and monocyte function. Clin Nutr 1983; 2:37-40. [PMID: 16829406 DOI: 10.1016/0261-5614(83)90028-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Peripheral blood lymphocyte function (PHA) was unaffected by Intralipid in patients receiving lipid as part of a parenteral nutrition regime, and in volunteers receiving a small intravenous bolus. However monocyte function (chemotaxis) was significantly impaired by Intralipid in both groups. Three measures of monocyte function confirmed depression following in vitro exposure to Intralipid. Electronmicrographs of circulating monocytes and autoradiographs of cells exposed to 14C-Intralipid in vitro suggested that this detrimental effect on monocytes may follow phagocytosis of lipid particles. These findings suggest that caution should be exercised with the use of Intralipid in patients at particular risk of sepsis.
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Affiliation(s)
- I Fraser
- Department of Surgery, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester UK
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21
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Abstract
The serum of over half of a group of acutely ill patients agglutinated "Intralipid' a fat emulsion based on soya bean oil designed for intravenous infusion. This reaction is probably precipitated by C-reactive protein in the presence of calcium ions. Post-mortem examinations of patients who had received intralipid showed evidence of microembolism which could have been caused by agglutination of intralipid. If this is the case then intralipid should perhaps not be given to these acutely ill patients.
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